Functional endoscopic sinus surgery (FESS) is currently the most common type of surgery used to treat chronic sinusitis. In a typical FESS procedure, an endoscope is inserted into the nostril along with one or more surgical instruments. The surgical instruments are then used to cut tissue and/or bone, cauterize, suction, etc. In most FESS procedures, the natural ostium (e.g., opening) of at least one paranasal sinus is surgically enlarged to improve drainage from the sinus cavity. The endoscope provides a direct line-of-sight view whereby the surgeon is typically able to visualize some but not all anatomical structures within the surgical field. Under visualization through the endoscope, the surgeon may remove diseased or hypertrophic tissue or bone and may enlarge the ostia of the sinuses to restore normal drainage of the sinuses. FESS procedures can be effective in the treatment of sinusitis and for the removal of tumors, polyps and other aberrant growths from the nose.
The surgical instruments used in prior art FESS procedures have included applicators, chisels, curettes, elevators, forceps, gouges, hooks, knives, saws, mallets, morselizers, needle holders, osteotomes, ostium seekers, probes, punches, backbiters, rasps, retractors, rongeurs, scissors, snares, specula, suction cannulae and trocars. The majority of such instruments are of substantially rigid design.
In order to adequately view the operative field through the endoscope and/or to allow insertion and use of rigid instruments, many FESS procedures of the prior art have included the surgical removal or modification of normal anatomical structures. For example, in many prior art FESS procedures, a total uncinectomy (e.g., removal of the uncinate process) is performed at the beginning of the procedure to allow visualization and access of the maxilary sinus ostium and/or ethmoid bulla and to permit the subsequent insertion of the rigid surgical instruments. Indeed, in most traditional FESS procedures, if the uncinate process is allowed to remain, such can interfere with endoscopic visualization of the maxillary sinus ostium and ethmoid bulla, as well as subsequent dissection of deep structures using the available rigid instrumentation.
More recently, new devices, systems and methods have been devised to enable the performance of FESS procedures and other ENT surgeries with minimal or no removal or modification of normal anatomical structures. Such new methods include, but are not limited to, uncinate-sparing procedures using Balloon Sinuplasty™ tools and uncinate-sparing ethmoidectomy procedures using catheters, non-rigid instruments and advanced imaging techniques (Acclarent, Inc., Menlo Park, Calif.). Examples of these new devices, systems and methods are described in incorporated U.S. patent application Ser. No. 10/829,917, entitled Devices, Systems and Methods for Diagnosing and Treating Sinusitis and Other Disorders of the Ears, Nose and/or Throat; Ser. No. 10/944,270, entitled Apparatus and Methods for Dilating and Modifying Ostia of Paranasal Sinuses and Other Intranasal or Paranasal Structures; Ser. No. 11/116,118, entitled Methods and Devices for Performing Procedures Within the Ear, Nose, Throat and Paranasal Sinuses; and Ser. No. 11/150,847, entitled Devices, Systems and Methods Useable for Treating Sinusitis, each of which is hereby incorporated herein, in its entirety. Procedures using Balloon Sinuplasty™ tools, such as those described in the above-noted applications, for example, may be performed using various types of guidance, including but not limited to C-arm fluoroscopy, transnasal endoscopy, optical image guidance and/or electromagnetic image guidance.
In FESS and Balloon Sinuplasty™ procedures, the surgeon typically holds an endoscope with one hand while using the other hand to manipulate surgical instruments. Recognizing the desirability of integrating an endoscope with an operative device so that both could be moved with a single hand, application Ser. No. 11/193,020, entitled Methods and Apparatus for Treating Disorders of the Ear, Nose and Throat (hereby incorporated by reference) describes a number of transnasally insertable sinus guides coupled or integrated with endoscopes.
Currently available endoscopes used in ear, nose and throat procedures are generally rigid endoscopes that view in only one direction—i.e., either straight ahead or at a fixed angle. At the same time, the nasal/paranasal anatomy is one of many folded and curved structures made of bone covered with soft tissue, thus often making it very challenging to advance and view anatomy with a rigid unidirectional endoscope. For example, it may be quite challenging to advance an endoscope into the nose and around the uncinate process to view the ostium of the maxillary sinus. In fact, this is at least one reason why the uncinate process is removed in traditional FESS procedures. Although angled endoscopes are available, to view the anatomy as desired a surgeon may often need to use multiple different endoscopes during a procedure, switching between endoscopes as different views are desired. This can be quite awkward and cumbersome as well as expensive.
Therefore, there is a need for new devices and methodology to facilitate endoscopic viewing of anatomy, guidewires, catheters and/or other devices in intracranial procedures, such as ear, nose and throat procedures like paranasal sinus surgery. Ideally, such devices and methods would involve direct viewing of anatomy and surgical tools using an endoscope. Also ideally, such an endoscope would be easy to manipulate and use and would be compatible with a variety of surgical tools and systems. At least some of these objectives will be met by the embodiments of the present invention.